Emergency stenting of the left main coronary artery after diagnostic coronary angiography.

v P a a p a l o v g t a c c g e 76-year-old female presented with an acute oronary syndrome manifested by chest pain, a new eft bundle branch block, and positive troponin. he had a previous history of aortic valve replaceent. Emergent diagnostic coronary angiography ia the right femoral arterial approach with a 5-F eft Judkins 4.0 catheter demonstrated significant eft main coronary artery (LMCA) stenosis (Fig. 1, nline Video 1). Immediately following the aniogram, the patient became hypotensive, asystolic, nd unresponsive. Advanced cardiac life support rotocol was started promptly and the patient was ntubated. A temporary pacemaker was placed in ddition to an intra-aortic balloon pump, via the eft femoral approach. Inotropes were started. Agressive and continuous chest compressions were erformed during the entire procedure. A 7-F Left udkins 3.5 guide catheter was used to engage the stium of the LMCA. The lesion was crossed with ifficulty with a 0.014-inch Whisper high-torque uide wire (Abbott Corporation, San Francisco, alifornia) after multiple guidewires had failed. re-dilation was performed with a 2.0 15-mm averick balloon (Boston Scientific Corporation, atick, Massachusetts) followed by placement of a .5 12-mm Driver bare-metal stent (Medtronic nc., Minneapolis, Minnesota) (Fig. 2, Online ideo 2) during chest compressions. Thrombolysis n Myocardial Infarction (TIMI) flow grade 3 was chieved (Fig. 3, Online Video 3) with gradual emodynamic improvement. The patient had full ecovery and was discharged 3 days later on longerm daily doses of aspirin 325 mg and clopidogrel 5 mg. A follow-up angiogram at 3 months demnstrated patency of the LMCA stent.